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Pattern of cancer according to ICD-10 classification.

Table 1. The pattern of cancer according to ICD-10 classification from 2008 to 2018

ICD10	Position	Frequency	Percentage
C00-C14	Lip, oral cavity and pharynx	71	3.5
C15-C26	Digestive organs	844	42.0
C30-C39	Respiratory and intrathoracic organs	370	18.4
C40-C41	Bone and articular cartilage	4	0.2
C43-C44	Skin	36	1.8
C45-C49	Mesothelial and soft tissue	4	0.2
C50	Breast	262	13.0
C51-C58	Female genital organs	67	3.3
C60-C63	Male genital organs	19	0.9
C64-C68	Urinary tract	78	3.9
C69-C72	Eye, brain and nervous system	12	0.6
C73-C75	Thyroid and other endocrine glands	117	5.8
C76-C80	Unspecified sites	44	2.2
C81-C96	Lymphoid, haematopoietic, related tissue	80	4.0
	Total	2008	100.0

Out of the total 2,008 cases, 844 cases were malignant neoplasms of digestive organs (42.0%). This was followed by malignant neoplasms of respiratory and intrathoracic organs with 370 cases (18.4%). At the lowest position were cancer of bone and articular cartilage, mesothelial and soft tissue, at 0.2% each.

Figure 1. Top 10 cancers in both sexes

Out of total 2008 patients, cancer of lung (16.9%), liver (15.2%) and breast (13.0%) were the most frequent cancers in both sexes.

Pattern of cancer according to patient’s characteristics

In terms of gender

Figure 2. Top 10 cancers in both sexes from 2008 to 2018

Liver cancer (22.2%) was the most common type in males and breast cancer (28.7%) was the leading cancer in females. Lung cancer was the second cancer in both sexes, male-20.4% and females-12.5%. Thyroid cancer was the third leading site (10.2%) among females while it was tenth in males (2.1%).

In terms of age groups

Table 2. Pattern of cancer according to age groups

Age groups	<30	30-39	40-49	50-59	60-69	70-79	>80
Lip, oral cavity and pharynx	4,2	5,6	21,1	26,8	23,9	12,7	5,6
Digestive organs	1,4	4,0	15,2	27,0	24,8	17,1	10,5
Respiratory and intrathoracic organs	0,5	4,1	10,5	25,7	29,7	20,8	8,6
Bone and articular cartilage	75,0	-	-	25,0	-	-	-
Skin	2,8	-	2,8	27,8	13,9	27,8	25,0
Mesothelial and soft tissue	-	-	50,0	-	-	50,0	-
Breast	1,9	8,4	32,1	31,7	14,5	7,6	3,8
Female genital organs	6,0	6,0	19,4	32,8	23,9	10,4	1,5
Male genital organs	-	5,3	5,3	10,5	42,1	26,3	10,5
Urinary tract	2,6	2,6	11,5	19,2	17,9	30,8	15,4
Eye, brain and nervous system	16,7	16,7	16,7	33,3	8,3	8,3	-
Thyroid and other endocrine glands	22,2	17,1	31,6	21,4	5,1	2,6	-
Unspecified sites	2,3	2,3	15,9	36,4	22,7	15,9	-
Lymphoid, haematopoietic, related tissue	14,1	5,1	11,5	21,8	28,2	17,9	1,3
Total (%)	3,6	5,4	17,3	26,8	22,7	16,1	8,1

The most common age group was 50-59 that covered more than a quarter cancer patients (26.8%). Malignant of male genital organs, urinary tract made up the highest percentage in advanced age groups (60-79) whereas malignant of breast, thyroid and other endocrine glands recorded the highest figure in the younger one (40-49).

In terms of regions

Figure 3. Distribution of the 5 most common cancers by geographic regions

In the coastal areas, stomach cancer accounted for the highest percentage (20.1%). In rural and urban areas, lung cancer constituted the largest proportion (18.9% and 17.0% respectively). In mountainous areas, liver cancer overtook lung cancer to register the highest figure out of all categories surveyed (18.9%).

General characteristics of the cancer patients

Out of the total 2,008 cancer cases, the mean age of cancer patients was 58.3± 14.9 years. Among them, the smallest was 7 and the largest was 98. The most common age group of cancer was 50-59 years (26.8%), followed by the 60-69 age group (22.7%). With regards to gender, the male to female ratio was 1.2:1. Cancer patient’s occupational profiles were varied, with the majority belonging to tired/aged group (41.5%), followed by farmer/worker (32.8%); other occupations made up lower figures. 72.4% of cancer patients resided in Thua Thien Hue province.

Figure 4. Number of cancer cases by year and sex from 2008 to 2018

From 2008 to 2018, there was a significant increase in the number of newly diagnosed and treated cancer cases at Hue University Hospital Medical.

Figure 5. Age and Gender distribution of cancer patients

In the age groups under 50 years, the number of female cases was higher than that of males and reverse trend was observed in the remaining age categories.

Basis Diagnosis

Table 3. Basis Diagnosis

Basis Diagnosis	Frequency	Percentage
Histology/ Cytology	1726	86.0
Radiology examinations	280	13.9
Others	2	0.1
Total	2008	100.0

86.0% of cases had microscopic confirmation of the diagnosis, either histological or cytological and 13.9% on the basis of radiology examination.

Histopathologic types

In terms of lung cancers, non-small cell carcinoma (NSCC) made up 94.4% and small cell carcinoma (SCLC) comprised the remaining 5.6%. Squamous cell carcinoma was the most common type of lung cancers, representing 35.7% of lung cancers, 37.8% of the NSCC. Adenocarcinoma came a close second at 31.3% of the NSCC. Large cell carcinoma and adenosquamous carcinoma were rare types of NSCC, with the former accounting for 2.5% of the cases and the latter took up 2.9%.

Invasive ductal carcinoma was the predominantly histological presentation (82.5%) of breast cancers and papillary carcinoma was found to be the most common variety in thyroid carcinomas.

Stage of cancer

Table 3. Disease stage at diagnosis

Site of cancer	Stage = II		Stage = III		Total
	Cases	%	Cases	%
Lung	38	13.2	250	86.8	288
Liver	27	31.8	58	68.2	85
Breast	187	74.8	63	25.2	250
Stomach	55	47.0	62	53.0	117
Colorectum	38	35.2	70	64.8	108
Thyroid	50	79.4	13	20.6	63
Oesophagus	12	36.4	21	63.6	33
Cervix	19	82.6	4	17.4	23
Non Hodgkin	15	41.7	51	58.3	36
Others	39	31.2	90	68.8	125
Total	480	42.6	648	57.4	1128

There were 1128 patients were assigned cancer stage (56.2%). Among them, 648 patients were presented with a late-stage (over stage III) (57.4%). Lung cancer took the top position with regard to late-stage at 86.8%. This was followed by liver cancer at 68.2%. In terms of early-stage (= stage II), cervix cancer topped the table at 82.6%, followed by thyroid cancer 79.4% and breast cancer 74.8%.

In breast cancer patients: 76.7% of them showed with stage T2 or higher, 58.8% had lymph node metastasis and 12.6% cases of distant metastases at the time of diagnosis.

Treatment modality

Table 4. The first treatment modalities

Treatment	Frequency	Percentage
Surgery	879	43.8
Gamma knife Radiosurgery	142	7.1
Chemotherapy	273	13.6
Surgery plus Radiosurgery	37	1.8
Surgery plus Chemotherapy	92	4.6
Chemotherapy plus Radiosurgery	32	1.6
Symptomatic	553	27.5
Total	2008	100.0

Surgery was the first mainstay for treatment of various types of cancer (43.8%), followed by symptomatic and chemotherapy (27.5% and 13.6% respectively). Other treatment methods constituted lower figures.

Comorbidity

Figure 6. Comorbidity

Concerning comorbidities, 9.8% of cancer patients were diagnosed with hypertension. The figures for diabetes type 2 and hepatitis B or C Virus were 3.1% and 8.2% respectively.

0.6% cancer patients were diagnosed with hepatic or kidney failure.